Last update: Nov. 23, 2019

Maternal Cytomegalovirus

Very Low Risk for breastfeeding


Safe. Compatible.
Minimal risk for breastfeeding and infant.

Cytomegalovirus (CMV) is a virus that belongs to herpesvirus family. Between 30 and 100% of adults become infected throughout their lives. The infection is usually asymptomatic or very mild without treatment required. Once overcome, the virus remains latent within the body to be reactivated occasionally.
Only intrauterine congenital infection has a higher rate of severe disease.



CMV is found in 50 to 97% of breastmilk samples obtained from healthy women, yet only 15 to 19% of infants become infected, and only 4% develope symptoms which may be generally fairly mild and no treatment is required (Jang 2016, Martins 2016, Romero 2015, García 2015, Lanzieri 2013, Kurath 2010). 

More serious infections have been reported (Sordelli 2015) that happened in less than 1% of at-term infants.



As lower the gestational age as greater the probability of appearance of symptomatic cases (Martins 2016, Yoo 2015), although in some series no differences between premature infants and term infants were found (Lanzieri 2013).



On very preterm births, mostly among infants with an age lower than 30 weeks and a birthweight lower than 1,000 g, CMV infection acquired through breastmilk may cause more severe symptoms that would require treatment with Ganciclovir (Mehler 2014, Okulu2012, Lombardi 2012). However, frequency rate is usually very low without occurrence of neurological and / or other long-term sequelae (Jim 2015, Bevot 2012), albeit some authors have detected small differences on some neurologic developmental scales (Goelz 2013).

Since some cases of especially serious infections have been reported in premature infants (Anne 2016, Oulu 2012, Chiavarini 2011), some authors recommend infant feeding by using frozen and / or pasteurized breastmilk (Romero 2015, Lawrence 2013, Chiavarini 2011); Others believe that an individual decision must be made according to the clinical circumstances of every premature infant (Lombardi 2012).
By freezing breastmilk the CMV content is reduced (Balcells 2016), but not eliminated (Omarsdottir 2015). Pasteurization does eliminate viral load in breastmilk (Yoo 2015), however, it affects bioactive and nutrient factors of breastmilk (Lombardi 2012) and the risk for necrotizing enterocolitis may be increased (Stock 2015).
 


There is a widespread consensus on that breastfeeding is not contraindicated on full-term infants whose mothers are CMV-positive on serologic tests.
 For most authors and scientific societies, fresh breastmilk is preferred for the routine feeding of all newborns, including preterm infants (AAP 2012, Kurath 2010), since the benefits of breastmilk outweigh the risks for clinical disease and / or neurological sequelae and because the risk associated to severe CMV disease through breast milk has been overestimated (Resch 2013).


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Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

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References

  1. Balcells C, Botet F, Gayete S, Marcos MÁ, Dorronsoro I, de Alba C, Figueras-Aloy J; Castrillo Study Group.. Vertically transmitted cytomegalovirus infection in newborn preterm infants. J Perinat Med. 2016 Abstract
  2. Jang HL, Cho JY, Kim MJ, Kim EJ, Park EY, Park SA, Kim IY, Choi YS, Bae CW, Chung SH. The Experience of Human Milk Banking for 8 Years: Korean Perspective. J Korean Med Sci. 2016 Abstract
  3. Martins-Celini FP, Yamamoto AY, Passos DM, do Nascimento SD, Lima EV, Di Giovanni CM, Quadrado ER, Barta R, Aragon DC, do Prado SI, de Almeida MF, Mussi-Pinhata MM. Incidence, Risk Factors, and Morbidity of Acquired Postnatal Cytomegalovirus Infection Among Preterm Infants Fed Maternal Milk in a Highly Seropositive Population. Clin Infect Dis. 2016 Abstract
  4. Anne-Aurélie L, Souad B, Leila K. Clinical Findings and Autopsy of a Preterm Infant with Breast Milk-Acquired Cytomegalovirus Infection. AJP Rep. 2016 Abstract
  5. Garcia-Loygorri MC, De Luis D, Torreblanca B, March GA, Bachiller MR, Eiros JM. La leche materna como vehículo de transmisión de virus. [Beast Milk as vehicle of transmission of virus]. Nutr Hosp. 2015 Abstract Full text (link to original source) Full text (in our servers)
  6. Stock K, Griesmaier E, Brunner B, Neubauer V, Kiechl-Kohlendorfer U, Trawöger R. Pasteurization of breastmilk decreases the rate of postnatally acquired cytomegalovirus infections, but shows a nonsignificant trend to an increased rate of necrotizing enterocolitis in very preterm infants--a preliminary study. Breastfeed Med. 2015 Abstract
  7. Romero-Gómez MP, Cabrera M, Montes-Bueno MT, Cendejas-Bueno E, Segovia C, Pastrana N, Mingorance J, Omeñaca F. Evaluation of cytomegalovirus infection in low-birth weight children by breast milk using a real-time polymerase chain reaction assay. J Med Virol. 2015 Abstract
  8. Omarsdottir S, Casper C, Navér L, Legnevall L, Gustafsson F, Grillner L, Zweygberg-Wirgart B, Söderberg-Nauclér C, Vanpée M. Cytomegalovirus infection and neonatal outcome in extremely preterm infants after freezing of maternal milk. Pediatr Infect Dis J. 2015 Abstract
  9. Sordelli N, Sapia E, Delgado M, Mistchenko A, Dastugue M. [Symptomatic cytomegalovirus infection through breastfeeding in a 45 days old boy]. Arch Argent Pediatr. 2015 Abstract
  10. Yoo HS, Sung SI, Jung YJ, Lee MS, Han YM, Ahn SY, Chang YS, Park WS. Prevention of Cytomegalovirus Transmission via Breast Milk in Extremely Low Birth Weight Infants. Yonsei Med J. 2015 Abstract
  11. Jim WT, Chiu NC, Ho CS, Shu CH, Chang JH, Hung HY, Kao HA, Chang HY, Peng CC, Yui BH, Chuu CP. Outcome of Preterm Infants With Postnatal Cytomegalovirus Infection via Breast Milk: A Two-Year Prospective Follow-Up Study. Medicine (Baltimore). 2015 Abstract Full text (link to original source) Full text (in our servers)
  12. Mehler K, Oberthuer A, Lang-Roth R, Kribs A. High rate of symptomatic cytomegalovirus infection in extremely low gestational age preterm infants of 22-24 weeks' gestation after transmission via breast milk. Neonatology. 2014 Abstract
  13. Resch B. The dilemma of breastfeeding very low birth weight infants at risk for symptomatic cytomegalovirus infection. J Matern Fetal Neonatal Med. 2013 Abstract Full text (link to original source) Full text (in our servers)
  14. Lanzieri TM, Dollard SC, Josephson CD, Schmid DS, Bialek SR. Breast milk-acquired cytomegalovirus infection and disease in VLBW and premature infants. Pediatrics. 2013 Abstract Full text (link to original source) Full text (in our servers)
  15. Goelz R, Meisner C, Bevot A, Hamprecht K, Kraegeloh-Mann I, Poets CF. Long-term cognitive and neurological outcome of preterm infants with postnatally acquired CMV infection through breast milk. Arch Dis Child Fetal Neonatal Ed. 2013 Abstract
  16. Lawrence RM. Circumstances when breastfeeding is contraindicated. Pediatr Clin North Am. 2013 Feb;60(1):295-318. Abstract
  17. Bevot A, Hamprecht K, Krägeloh-Mann I, Brosch S, Goelz R, Vollmer B. Long-term outcome in preterm children with human cytomegalovirus infection transmitted via breast milk. Acta Paediatr. 2012 Abstract
  18. AAP. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012 Abstract Full text (link to original source) Full text (in our servers)
  19. Lombardi G, Garofoli F, Manzoni P, Stronati M. Breast milk-acquired cytomegalovirus infection in very low birth weight infants. J Matern Fetal Neonatal Med. 2012 Abstract Full text (link to original source) Full text (in our servers)
  20. Okulu E, Akin IM, Atasay B, Ciftçi E, Arsan S, Türmen T. Severe postnatal cytomegalovirus infection with multisystem involvement in an extremely low birth weight infant. J Perinatol. 2012 Abstract
  21. Red Book. Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2012 Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, Red Book 2012
  22. Chiavarini M, Bragetti P, Sensini A, Cenci E, Castronari R, Rossi MJ, Fantauzzi A, Minelli L. Breastfeeding and transmission of cytomegalovirus to preterm infants. Case report and kinetic of CMV-DNA in breast milk. Ital J Pediatr. 2011 Abstract
  23. Kurath S, Halwachs-Baumann G, Müller W, Resch B. Transmission of cytomegalovirus via breast milk to the prematurely born infant: a systematic review. Clin Microbiol Infect. 2010 Abstract Full text (link to original source) Full text (in our servers)

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